| 蒋佳佳,刘红,王玉净,房朝晖,张倩影,李魁秀.宫颈癌术后盆腔复发患者放射治疗效果及预后的影响因素[J].中华放射医学与防护杂志,2019,39(3):208-212 |
| 宫颈癌术后盆腔复发患者放射治疗效果及预后的影响因素 |
| Efficacy and prognosis of radiotherapy for patients with postoperative pelvic recurrence in uterine cervical cancer |
| 投稿时间：2018-05-19 |
| DOI：10.3760/cma.j.issn.0254-5098.2019.03.009 |
| 中文关键词: 宫颈癌术后 盆腔复发 放射治疗 不良反应 生存率 |
| 英文关键词:Postoperative cervical cancer Pelvic recurrence Radiotherapy Toxicities Survival rate |
| 基金项目:卫生行业科研专项（201002009） |
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| 中文摘要: |
| 目的 分析宫颈癌术后盆腔复发患者放射治疗的疗效及不良反应。方法 回顾性分析2004年8月至2016年12月河北医科大学第四医院收治的宫颈癌手术治疗后盆腔复发的患者147例，所有患者均行放射治疗伴或不伴化疗。根据不同的临床因素和病理因素进行分组，logistic回归分析宫颈癌术后盆腔复发患者放疗效果的相关影响因素，采用Kaplan-Meier法统计生存率，并绘制相应生存曲线，生存率及预后相关因素对比使用Log-rank法。采用COX比例风险回归模型进行多因素分析。治疗后不良反应分析采用卡方检验。结果 中位随访时间为33.2个月，95%的患者完成剂量≥ 67 Gy（放疗剂量中位数）的放射治疗，完全缓解（CR）91例（61.9%）。患者5年局部控制率（LC）、无进展生存率（PFS）、无远处转移生存率（DMFS）和总生存率（OS）分别为63.6%、56.0%、73.9%和55.0%。单因素logistic回归分析显示，国际妇产科联盟（FIGO）分期（0~IB期与ⅡA~ⅡB期）、盆腔侧壁是否受累、复发肿瘤体积为宫颈癌术后盆腔复发患者治疗后完全缓解的相关因素（P<0.05）；多因素统计分析发现，FIGO分期、盆腔侧壁是否受侵是影响宫颈癌术后盆腔复发患者治疗效果和生存的独立因素（P<0.05）；宫颈癌术后盆腔复发盆壁受侵患者出现≥ 2级放射性直肠炎的发生率高于盆壁未受侵者，分别为26.9%和16.7%。结论 本研究表明宫颈癌术后盆腔复发患者经放疗后不良反应可耐受，且盆壁受侵患者不良反应发生率明显高于盆壁未受侵者；术前分期、盆壁是否受侵是影响宫颈癌术后盆腔复发患者放疗效果及远期预后的独立影响因素。 |
| 英文摘要: |
| Objective To analyze the result and adverse reactions of radiation therapy in patients with pelvic recurrence following cervical cancer postoperative. Methods A retrospective analysis of 147 patients with pelvic recurrence after surgical treatment of cervical cancer in the Fourth Hospital of Hebei Medical University from August 2004 to December 2016 was performed. All patients received radiotherapy with or without chemotherapy. According to different clinical factors and pathological factors, Logistic regression analysis was used to analyze the factors influencing radiotherapy outcomes in patients with pelvic recurrence after cervical cancer surgery. The Kaplan-Meier method was used to analyze the survival rate, and the corresponding survival curve was drawn. The survival rate and prognosis related factors were compared by using the log-rank test. The COX proportional hazards regression model was used for multivariate analysis of statistically relevant factors in univariate analysis. After treatment, toxicities were analyzed using chi-square test. Results The median follow-up time was 33.2 months. 95% of the patients completed radiation therapy with a dose of ≥ 67 Gy (median radiotherapy dose), and 91 patients (61.9%) had complete remission (CR). The 5-year local control (LC), progression-free survival (PFS), distant metastasis-free survival (DMFS), and overall survival (OS) were 63.6%, 56.0%, 73.9%, and 55.0%, respectively. Univariate logistic regression analysis showed that FIGO staging (stage 0-ⅠB and ⅡA-ⅡB), pelvic sidewall involvement, and recurrent tumor volume were associated with complete remission (P<0.05). Multivariate statistical analysis found that FIGO staging and pelvic sidewall invasion were independent factors influencing the efficacy and survival of patients with pelvic recurrence after cervical cancer surgery (P<0.05). Patients with pelvic wall invasion after cervical cancer surgery had a higher incidence of ≥ grade 2 proctitis than those without pelvic walls involved, which were 26.9% and 16.7%, respectively. Conclusions This study shows that after the surgical treatment of cervical cancer patients with pelvic recurrence can be tolerated by toxicities after radiation therapy. In addition, the incidence of toxicities in patients with pelvic wall invasion was significantly higher than those without pelvic wall invasion. Preoperative staging and the pelvic wall involvement are independent influencing factors influencing the effect of radiotherapy and long-term prognosis in patients with pelvic recurrence after cervical cancer surgery. |
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